Kworweinski Lafontant, Amber Blount, Jethro Raphael M Suarez, David H Fukuda, Jeffrey R Stout, Evette M Trahan, Nichole R Lighthall, Joon-Hyuk Park, Rui Xie, Ladda Thiamwong
<strong>Purpose:</strong> The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults.<br/><strong>Patients and Methods:</strong> This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests.<br/><strong>Results:</strong> The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%.<br/><strong>Conclusion:</strong> The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.<br/><br/><strong>Plain Language Summary:</strong> Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI chec
{"title":"Comparing Sensitivity, Specificity, and Accuracy of Fall Risk Assessments in Community-Dwelling Older Adults","authors":"Kworweinski Lafontant, Amber Blount, Jethro Raphael M Suarez, David H Fukuda, Jeffrey R Stout, Evette M Trahan, Nichole R Lighthall, Joon-Hyuk Park, Rui Xie, Ladda Thiamwong","doi":"10.2147/cia.s453966","DOIUrl":"https://doi.org/10.2147/cia.s453966","url":null,"abstract":"<strong>Purpose:</strong> The US Centers for Disease Control and Prevention (CDC) has implemented the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. This initiative provides an algorithm for fall risk screening. However, the algorithm has the potential to overcategorize individuals as high risk for falling upon initial screening, which may burden clinicians with the task of recategorizing individuals after follow-up testing. Therefore, this study aimed to compare the accuracy, sensitivity, and specificity of fall risk appraisal between the STEADI, Short Fall-Efficacy Scale International (FES-I), and portable balance system (BTrackS) assessments in community-dwelling older adults.<br/><strong>Patients and Methods:</strong> This cross-sectional analysis included 122 community-dwelling older adults, comprising 94 women and 28 men. Center-of-pressure postural sway was assessed using the BTrackS, fear of falling was assessed using the Short FES-I questionnaire, and all participants completed the STEADI checklist. Each assessment categorized participants as either high or low fall risk and fall risk appraisal was compared between groups using McNemar tests.<br/><strong>Results:</strong> The STEADI checklist (high risk: n = 62; low risk: n = 60) significantly differed in fall risk appraisal compared to the BTrackS (high risk: n = 44; low risk: n = 78; p = 0.014) and the Short FES-I (high risk: n = 42; low risk: n = 80; p = 0.002). Compared to the BTrackS, the STEADI checklist had a specificity of 62.8%, sensitivity of 70.5%, and accuracy of 65.6%. Compared to the Short FES-I, the STEADI checklist had a specificity of 67.5%, sensitivity of 81.0%, and accuracy of 72.1%.<br/><strong>Conclusion:</strong> The STEADI checklist appears to overcategorize individuals as high fall risk more frequently than direct assessments of postural sway and fear of falling. Further research is needed to examine potential improvements in accuracy when combining the STEADI checklist with direct assessments of postural sway and/or fear of falling.<br/><br/><strong>Plain Language Summary:</strong> Fall risk assessments are crucial for preventative care in older adults. However, the demands of clinical practice require an accurate and time-efficient method. The U.S Centers for Disease Control and Prevention (CDC) has implemented a fall risk checklist through the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative. However, the STEADI checklist might cost clinicians more time than expected, as some patients initially classified as high risk for falling may not actually be at high risk. This leads to unnecessary follow-up assessments. In this study, we compared the STEADI checklist to direct measures of postural sway (balance) using the BTrackS system and fear of falling using the Short FES-I survey to determine how they differed in classifying community-dwelling older adults as high versus low fall risk. Our results show that the STEADI chec","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"50 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140316564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jian Zhou, Ya-Jie Li, Xiao-Dong Zhou, Li-Juan Wang
Background: Rate-pressure product (RPP) calculated by multiplying heart rate by systolic blood pressure, is a convenient indicator closely associated with cardiac work or myocardial oxygen consumption. It has been reported to relate strongly to important indices of cardiovascular risk in patients with myocardial ischemia. However, its relationship with short- and long-term mortality in patients with acute coronary syndrome (ACS) undergoing primary PCI/immediate invasive strategy has not been defined. Methods: This study analyzed 1301 consecutive ACS patients who had undergone primary PCI, between January 2018 and September 2021. Patients with systolic BP < 90 mmHg were excluded to avoid the confounding effect of cardiogenic shock. RPP values were collected on admission and were divided into four groups: RPP ≤ 7.4, 7.4 ≤ 8.8, 8.8 < 8.8 < RPP8, and RPP > 10.8. Clinical endpoints were in-hospital cardiac and long-term all-cause mortality. The predictive performance was assessed by C-statistic, multivariate analysis and survival analysis. Results: Multivariate analysis showed that these in the highest vs lowest category of RPP (> 10.8 vs ≤ 7.4) had OR of 4.33 (95% CI=1.10 − 17.01; P = 0.036) in in-hospital cardiac mortality and 3.15 (95% CI=1.24 − 8.00; P = 0.016) in long-term all-cause mortality. In C-statistic analyses, RPP was a strong predictor in ACS, STEMI or UA/NSTEMI group for in-hospital cardiac mortality (AUC = 0.746, 95% CI = 0.722– 0.770, p < 0.001) and long-term all-cause mortality (AUC = 0.701, 95% CI = 0.675– 0.725, p < 0.001). The Kaplan–Meier event rate for long-term survival of RPP > 10.8 was significantly lower than that of RPP ≤ 10.8. Conclusion: RPP showed a positive association with in-hospital cardiac or long-term all-cause mortality in ACS patients undergoing primary PCI/immediate invasive strategy, and RPP > 10.8 can be as an independent predictor.
{"title":"Rate-Pressure Product is a Novel Predictor for Short- and Long-Term Mortality in Patients with Acute Coronary Syndrome Undergoing Primary PCI/Immediate Invasive Strategy","authors":"Jian Zhou, Ya-Jie Li, Xiao-Dong Zhou, Li-Juan Wang","doi":"10.2147/cia.s449905","DOIUrl":"https://doi.org/10.2147/cia.s449905","url":null,"abstract":"<strong>Background:</strong> Rate-pressure product (RPP) calculated by multiplying heart rate by systolic blood pressure, is a convenient indicator closely associated with cardiac work or myocardial oxygen consumption. It has been reported to relate strongly to important indices of cardiovascular risk in patients with myocardial ischemia. However, its relationship with short- and long-term mortality in patients with acute coronary syndrome (ACS) undergoing primary PCI/immediate invasive strategy has not been defined.<br/><strong>Methods:</strong> This study analyzed 1301 consecutive ACS patients who had undergone primary PCI, between January 2018 and September 2021. Patients with systolic BP < 90 mmHg were excluded to avoid the confounding effect of cardiogenic shock. RPP values were collected on admission and were divided into four groups: RPP ≤ 7.4, 7.4 ≤ 8.8, 8.8 < 8.8 < RPP8, and RPP > 10.8. Clinical endpoints were in-hospital cardiac and long-term all-cause mortality. The predictive performance was assessed by C-statistic, multivariate analysis and survival analysis.<br/><strong>Results:</strong> Multivariate analysis showed that these in the highest vs lowest category of RPP (> 10.8 vs ≤ 7.4) had OR of 4.33 (95% CI=1.10 − 17.01; P = 0.036) in in-hospital cardiac mortality and 3.15 (95% CI=1.24 − 8.00; P = 0.016) in long-term all-cause mortality. In C-statistic analyses, RPP was a strong predictor in ACS, STEMI or UA/NSTEMI group for in-hospital cardiac mortality (AUC = 0.746, 95% CI = 0.722– 0.770, p < 0.001) and long-term all-cause mortality (AUC = 0.701, 95% CI = 0.675– 0.725, p < 0.001). The Kaplan–Meier event rate for long-term survival of RPP > 10.8 was significantly lower than that of RPP ≤ 10.8.<br/><strong>Conclusion:</strong> RPP showed a positive association with in-hospital cardiac or long-term all-cause mortality in ACS patients undergoing primary PCI/immediate invasive strategy, and RPP > 10.8 can be as an independent predictor.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"28 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140203493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes. Methods: Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage. Results: Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over &dollar1 million with a per-patient enrolled savings of &dollar19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of &dollar4.95 million or &dollar15,618 per enrolled patient. Conclusion: Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.
Plain Language Summary: This study explored the feasibility and impact of implementing an evidence-based fall prevention model into emergency medical services for older adults. The outcomes resulted in an efficient and effective manner to screen older adults for falls during emergency response services and connect high-risk older adults with in-home follow-up care from community paramedics. In addition, fall prevention services were provided for vulnerable adults following a recent discharge from hospital care. These initiatives to address fall prevention resulted in a majority of older adults receiving preventive fall risk screening during emergency response calls, significant changes in quality of life measures for adults with multiple comorbidities and fall risk, and significant potential cost savings in reduced healthcare services.
Keywords: fall prevention, emergency providers, Mobile Integrated Healthcare, paramedics, age-friendly
{"title":"Integrating Fall Prevention Strategies into EMS Services to Reduce Falls and Associated Healthcare Costs for Older Adults","authors":"Kathlene Camp, Sara Murphy, Brandon Pate","doi":"10.2147/cia.s453961","DOIUrl":"https://doi.org/10.2147/cia.s453961","url":null,"abstract":"<strong>Purpose:</strong> The purpose of this study is to detail the implementation of fall prevention initiatives through emergency medical services (EMS) and associated outcomes.<br/><strong>Methods:</strong> Paramedics with MedStar Mobile Healthcare utilized the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention model to screen and direct intervention through 9-1-1 emergency response, High Utilization Group (HUG), and 30-day Hospital Readmission Avoidance (HRA) programs. Outcomes from 9-1-1 calls measured the number of older adults screened for falls and identified risk factors. The HUG and HRA programs measured change in quality of life with EuroQol-5D, referral service utilization, falls, emergent healthcare utilization, and hospital readmission data. Analysis included costs associated with reduced healthcare usage.<br/><strong>Results:</strong> Emergency paramedics provided fall risk screening for 50.5% (n=45,090) of adults aged 65 and older and 59.3% were at risk of falls, with 48.1% taking medications known to increase the risk of falls. Services provided through the HUG and HRA programs, along with additional needed referral services, resulted in a 37.2% reduction in fall-related 9-1-1 calls and a 29.5% increase in overall health status related to quality of life. Analysis of the HUG program revealed potential savings of over &dollar1 million with a per-patient enrolled savings of &dollar19,053. The HRA program demonstrated a 16.4% hospital readmission rate, in comparison to a regional average of 30.2%, and a cost-savings of &dollar4.95 million or &dollar15,618 per enrolled patient.<br/><strong>Conclusion:</strong> Implementation of the STEADI model into EMS services provides an effective and cost-saving model for addressing fall prevention for older adults, provides meaningful and impactful improvement for older adults, and could serve as a model for other EMS programs.<br/><br/><strong>Plain Language Summary:</strong> This study explored the feasibility and impact of implementing an evidence-based fall prevention model into emergency medical services for older adults. The outcomes resulted in an efficient and effective manner to screen older adults for falls during emergency response services and connect high-risk older adults with in-home follow-up care from community paramedics. In addition, fall prevention services were provided for vulnerable adults following a recent discharge from hospital care. These initiatives to address fall prevention resulted in a majority of older adults receiving preventive fall risk screening during emergency response calls, significant changes in quality of life measures for adults with multiple comorbidities and fall risk, and significant potential cost savings in reduced healthcare services.<br/><br/><strong>Keywords:</strong> fall prevention, emergency providers, Mobile Integrated Healthcare, paramedics, age-friendly<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"31 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140203802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eveline de Haan, Gert R Roukema, Veronique AJIM van Rijckevorsel, Tjallingius M Kuijper, Louis de Jong
Purpose: The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery. Patients and methods: A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis. Results: 8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90– 100 years (OR = 4.7, 95% CI: 1.07– 19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28– 100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97– 3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44– 3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25– 2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92– 0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98– 0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44– 2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01– 1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72– 3.38, p < 0.001). Conclusion: A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.
Keywords: hip fracture, mortality, independent risk factors, clinical outcomes
{"title":"Risk Factors for 30-Days Mortality After Proximal Femoral Fracture Surgery, a Cohort Study","authors":"Eveline de Haan, Gert R Roukema, Veronique AJIM van Rijckevorsel, Tjallingius M Kuijper, Louis de Jong","doi":"10.2147/cia.s441280","DOIUrl":"https://doi.org/10.2147/cia.s441280","url":null,"abstract":"<strong>Purpose:</strong> The primary objective of this study was to identify new risk factors and to confirm previously reported risk factors associated with 30-day mortality after hip fracture surgery.<br/><strong>Patients and methods:</strong> A prospective hip fracture database was used to obtain data. In total, 3523 patients who underwent hip fracture surgery between 2011 and 2021 were included. Univariable and multivariable logistic regression was used to screen and identify candidate risk factors. Twenty-seven baseline factors and 16 peri-operative factors were included in the univariable analysis and 28 of those factors were included in multivariable analysis.<br/><strong>Results:</strong> 8.6% of the patients who underwent hip fracture surgery died within 30 days after surgery. Prognostic factors associated with 30-day mortality after hip fracture surgery were as follows: age 90– 100 years (OR = 4.7, 95% CI: 1.07– 19.98, p = 0.041) and above 100 years (OR = 11.3, 95% CI: 1.28– 100.26, p = 0.029), male gender (OR = 2.6, 95% CI: 1.97– 3.33, p < 0.001), American Society of Anesthesiologists (ASA) 3 and ASA 4 (OR = 2.1, 95% CI: 1.44– 3.14, p < 0.001), medical history of dementia (OR = 1.7, 95% CI: 1.25– 2.36, p = 0.001), decreased albumin level (OR = 0.94, 95% CI: 0.92– 0.97, p < 0.001), decreased glomerular filtration rate (GFR) (OR = 0.98, 95% CI: 0.98– 0.99, p < 0.001), residential status of nursing home (OR = 2.1, 95% CI: 1.44– 2.87, p < 0.001), higher Katz Index of Independence in Activities of Daily Living (KATZ-ADL) score (OR = 1.1, 95% CI: 1.01– 1.16, p=0.018) and postoperative pneumonia (OR = 2.4, 95% CI: 1.72– 3.38, p < 0.001).<br/><strong>Conclusion:</strong> A high mortality rate in patients after acute hip fracture surgery is known. Factors that are associated with an increased mortality are age above 90 years, male gender, ASA 3 and ASA 4, medical history of dementia, decreased albumin, decreased GFR, residential status of nursing home, higher KATZ-ADL score and postoperative pneumonia.<br/><br/><strong>Keywords:</strong> hip fracture, mortality, independent risk factors, clinical outcomes<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"86 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140203492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yangyang Hui, Han Wang, Gaoyue Guo, Wanting Yang, Xuqian Zhang, Jie Yang, Fang Yang, Xiaoyu Wang, Xiaofei Fan, Binxin Cui, Xin Chen, Huanli Jiao, Chao Sun
Purpose: The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes. Patients and Methods: The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed. Setting/Participants: Totally, 420 patients with cirrhosis were recruited. Results: The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤ 0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome. Conclusion: A utility value ≤ 0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.
Keywords: EQ-5D, liver cirrhosis, mortality, readmission, disability-adjusted life year
{"title":"Association Between Quality of Life Defined by EuroQol Group 5 Dimension and Composite Inferior Outcome Among Inpatients with Cirrhosis","authors":"Yangyang Hui, Han Wang, Gaoyue Guo, Wanting Yang, Xuqian Zhang, Jie Yang, Fang Yang, Xiaoyu Wang, Xiaofei Fan, Binxin Cui, Xin Chen, Huanli Jiao, Chao Sun","doi":"10.2147/cia.s444842","DOIUrl":"https://doi.org/10.2147/cia.s444842","url":null,"abstract":"<strong>Purpose:</strong> The utility of the EuroQol Group 5 Dimension (EQ-5D) measuring health-related quality of life (HRQoL) has been verified; however, knowledge gaps remain concerning predictive performance in cirrhosis. We aimed to identify the optimal threshold for risk stratification and the pronounced domain in the EQ-5D linked to inferior outcomes.<br/><strong>Patients and Methods:</strong> The X-tile project was used to obtain a threshold, considering the composite outcome of 1-year all-cause mortality or readmission. A restricted cubic spline (RCS) was performed to test the non-linear relationship between the EQ-5D utility value and the primary outcome. Six multivariate Cox regression models incorporating EQ-5D utility value and each of the five domains were constructed.<br/><strong>Setting/Participants:</strong> Totally, 420 patients with cirrhosis were recruited.<br/><strong>Results:</strong> The median utility value of the study population was 0.77 and 59.8% reported impairment in minimal one EQ-5D domain. RCS indicated a linear relationship between the utility value and composite inferior outcome. X-tile pinpointed a utility value of 0.59 stratifying populations into high- and low-risk groups based on the outcome. Inpatients with cirrhosis and deteriorated HRQoL (utility value ≤ 0.59) were at higher risk of death or readmission (adjusted HR: 2.18, P < 0.001). Furthermore, mobility and usual activities were the most pronounced domains associated with composite inferior outcome.<br/><strong>Conclusion:</strong> A utility value ≤ 0.59 can identify cirrhotic inpatients exhibiting compromised HRQoL and mortality/readmission risk. It is tempting to reverse the decreased HRQoL by applying longitudinal measurements and keeping surveillance on utility value, while interventions appear to mainly focus on improving mobility and usual activities.<br/><br/><strong>Keywords:</strong> EQ-5D, liver cirrhosis, mortality, readmission, disability-adjusted life year<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"365 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140203567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To evaluate the performance of the Framingham cardiovascular risk score (FRS)/pooled cohort equations (PCE)/China prediction for atherosclerotic cardiovascular disease (ASCVD) risk (China-PAR model) in a prospective cohort of Chinese older adults. Patients and Methods: We assessed 717 older adults aged 75– 85 years without ASCVD at the baseline from the Sichuan province of China. The participants were followed annually from 2011 to 2021. We obtained the participants’ information through the medical records of physical examination and evaluated their 10-year ASCVD risk using FRS, PCE, and China-PAR. We further evaluated the predictive abilities of three assessment models. Results: During the 10-year follow-up, 206 participants developed ASCVD, with an incidence rate of 28.73%. The FRS and China-PAR moderately underestimated the risk of ASCVD (22.1% and 12.4%, respectively), but while PCE overestimated the risk (36.1%). FRS and China-PAR were found to underestimate the risk of ASCVD (26% and 63%, respectively) for men, while PCE overestimated the risk by 8%; For women, FRS and China-PAR were found to underestimate the risk of ASCVD (14% and 35%, respectively), while PCE overestimated the risk by 88%. Conclusion: The 10-year ASCVD risk was found to be overestimated by PCE. China-PAR had the most accurate predictions in women, while FRS was particularly well-calibrated in males. All three risk models have good discrimination, with FRS and PCE being well-calibrated in men and all three being well-calibrated in women. Therefore, accurate risk models are warranted to facilitate the prevention of ASCVD at the baseline among Chinese older adults.
{"title":"Comparative Analysis of Three Atherosclerotic Cardiovascular Disease Risk Prediction Models in Individuals Aged 75 and Older","authors":"Zhang Wang, Xue Yang, Longxin Li, Xiaobo Zhang, Wenlin Zhou, Sixue Chen","doi":"10.2147/cia.s454060","DOIUrl":"https://doi.org/10.2147/cia.s454060","url":null,"abstract":"<strong>Purpose:</strong> To evaluate the performance of the Framingham cardiovascular risk score (FRS)/pooled cohort equations (PCE)/China prediction for atherosclerotic cardiovascular disease (ASCVD) risk (China-PAR model) in a prospective cohort of Chinese older adults.<br/><strong>Patients and Methods:</strong> We assessed 717 older adults aged 75– 85 years without ASCVD at the baseline from the Sichuan province of China. The participants were followed annually from 2011 to 2021. We obtained the participants’ information through the medical records of physical examination and evaluated their 10-year ASCVD risk using FRS, PCE, and China-PAR. We further evaluated the predictive abilities of three assessment models.<br/><strong>Results:</strong> During the 10-year follow-up, 206 participants developed ASCVD, with an incidence rate of 28.73%. The FRS and China-PAR moderately underestimated the risk of ASCVD (22.1% and 12.4%, respectively), but while PCE overestimated the risk (36.1%). FRS and China-PAR were found to underestimate the risk of ASCVD (26% and 63%, respectively) for men, while PCE overestimated the risk by 8%; For women, FRS and China-PAR were found to underestimate the risk of ASCVD (14% and 35%, respectively), while PCE overestimated the risk by 88%.<br/><strong>Conclusion:</strong> The 10-year ASCVD risk was found to be overestimated by PCE. China-PAR had the most accurate predictions in women, while FRS was particularly well-calibrated in males. All three risk models have good discrimination, with FRS and PCE being well-calibrated in men and all three being well-calibrated in women. Therefore, accurate risk models are warranted to facilitate the prevention of ASCVD at the baseline among Chinese older adults.<br/><br/><strong>Keywords:</strong> ASCVD, risk prediction model, FRS, PCE, China-PAR<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"120 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140171339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions. Patients and Methods: Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of ≥ 1 point between the preoperative and postoperative scale was defined as POCD. Results: We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) ≥ 4.2%, STOP-Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF ≥ 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028– 5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057– 0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively. Conclusion: Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.
{"title":"Risk Factors for Postoperative Cognitive Decline After Orthopedic Surgery in Elderly Chinese Patients: A Retrospective Cohort Study","authors":"Xian Li, Hong Lai, Peng Wang, Shuai Feng, Xuexin Feng, Chao Kong, Dewei Wu, Chunlin Yin, Jianghua Shen, Suying Yan, Rui Han, Jia Liu, Xiaoyi Ren, Ying Li, Lu Tang, Dong Xue, Ying Zhao, Hao Huang, Xiaoying Li, Yanhong Zhang, Xue Wang, Chunxiu Wang, Ping Jin, Shibao Lu, Tianlong Wang, Guoguang Zhao, Chaodong Wang","doi":"10.2147/cia.s436349","DOIUrl":"https://doi.org/10.2147/cia.s436349","url":null,"abstract":"<strong>Purpose:</strong> We aimed to identify the risk factors for postoperative cognitive decline (POCD) by evaluating the outcomes from preoperative comprehensive geriatric assessment (CGA) and intraoperative anesthetic interventions.<br/><strong>Patients and Methods:</strong> Data used in the study were obtained from the Aged Patient Perioperative Longitudinal Evaluation–Multidisciplinary Trial (APPLE-MDT) cohort recruited from the Department of Orthopedics in Xuanwu Hospital, Capital Medical University between March, 2019 and June, 2022. All patients accepted preoperative CGA by the multidisciplinary team using 13 common scales across 15 domains reflecting the multi-organ functions. The variables included demographic data, scales in CGA, comorbidities, laboratory tests and intraoperative anesthetic data. Cognitive function was assessed by Montreal Cognitive Assessment scale within 48 hours after admission and after surgery. Dropping of ≥ 1 point between the preoperative and postoperative scale was defined as POCD.<br/><strong>Results:</strong> We enrolled 119 patients. The median age was 80.00 years [IQR, 77.00, 82.00] and 68 patients (57.1%) were female. Forty-two patients (35.3%) developed POCD. Three cognitive domains including calculation (P = 0.046), recall (P = 0.047) and attention (P = 0.007) were significantly worsened after surgery. Univariate analysis showed that disability of instrumental activity of daily living, incidence rate of postoperative respiratory failure (PRF) ≥ 4.2%, STOP-Bang scale score, Caprini risk scale score and Sufentanil for maintenance of anesthesia were different between the POCD and non-POCD patients. In the multivariable logistic regression analysis, PRF ≥ 4.2% (odds ratio [OR] = 2.343; 95% confidence interval [CI]: 1.028– 5.551; P = 0.046) and Sufentanil for maintenance of anesthesia (OR = 0.260; 95% CI: 0.057– 0.859; P = 0.044) was independently associated with POCD as risk and protective factors, respectively.<br/><strong>Conclusion:</strong> Our study suggests that POCD is frequent among older patients undergoing elective orthopedic surgery, in which decline of calculation, recall and attention was predominant. Preoperative comprehensive geriatric assessments are important to identify the high-risk individuals of POCD.<br/><br/><strong>Keywords:</strong> cognitive dysfunction, postoperative cognitive complications, orthopedic surgery, comprehensive geriatric assessment, risk factors<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"47 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140148444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Minghao Gu, SenSen Lv, Yihui Song, Hong Wang, Xingyu Zhang, Jing Liu, Deshun Liu, Xiudi Han, Xuedong Liu
Purpose: To investigate the clinical value of serum lysophosphatidylcholine (LPC) as a predictive biomarker for determining disease severity and mortality risk in hospitalized elderly patients with community-acquired pneumonia (CAP). Methods: This prospective, single-center study enrolled 208 elderly patients, including 67 patients with severe CAP (SCAP) and 141 with non-SCAP between November 1st, 2020, and November 30th, 2021 at the Qingdao Municipal Hospital, Shandong Province, China. The demographic and clinical parameters were recorded for all the included patients. Serum LPC levels were measured on day 1 and 6 after admission using ELISA. Propensity score matching (PSM) was used to balance the baseline variables between SCAP and non-SCAP patient groups. Receiver operative characteristic (ROC) curve analysis was used to compare the predictive performances of LPC and other clinical parameters in discriminating between SCAP and non-SCAP patients and determining the 30-day mortality risk of the hospitalized CAP patients. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with SCAP. Cox proportional hazard regression analysis was used to determine if serum LPC was an independent risk factor for the 30-day mortality of CAP patients. Results: The serum LPC levels at admission were significantly higher in the non-SCAP patients than in the SCAP patients (P = 0.011). Serum LPC level < 24.36 ng/mL, and PSI score were independent risk factors for the 30-day mortality in the elderly patients with CAP. The risk of 30-day mortality in the elderly CAP patients with low serum LPC levels (< 24.36ng/mL) was > 5-fold higher than in the patients with high serum LPC levels (≥ 24.36ng/mL). Conclusion: Low serum LPC levels were associated with significantly higher disease severity and 30-day mortality in the elderly patients with CAP. Therefore, serum LPC is a promising predictive biomarker for the early identification of elderly CAP patients with poor prognosis.
{"title":"Predictive Value of Lysophosphatidylcholine for Determining the Disease Severity and Prognosis of Elderly Patients with Community-Acquired Pneumonia","authors":"Minghao Gu, SenSen Lv, Yihui Song, Hong Wang, Xingyu Zhang, Jing Liu, Deshun Liu, Xiudi Han, Xuedong Liu","doi":"10.2147/cia.s454239","DOIUrl":"https://doi.org/10.2147/cia.s454239","url":null,"abstract":"<strong>Purpose:</strong> To investigate the clinical value of serum lysophosphatidylcholine (LPC) as a predictive biomarker for determining disease severity and mortality risk in hospitalized elderly patients with community-acquired pneumonia (CAP).<br/><strong>Methods:</strong> This prospective, single-center study enrolled 208 elderly patients, including 67 patients with severe CAP (SCAP) and 141 with non-SCAP between November 1st, 2020, and November 30th, 2021 at the Qingdao Municipal Hospital, Shandong Province, China. The demographic and clinical parameters were recorded for all the included patients. Serum LPC levels were measured on day 1 and 6 after admission using ELISA. Propensity score matching (PSM) was used to balance the baseline variables between SCAP and non-SCAP patient groups. Receiver operative characteristic (ROC) curve analysis was used to compare the predictive performances of LPC and other clinical parameters in discriminating between SCAP and non-SCAP patients and determining the 30-day mortality risk of the hospitalized CAP patients. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with SCAP. Cox proportional hazard regression analysis was used to determine if serum LPC was an independent risk factor for the 30-day mortality of CAP patients.<br/><strong>Results:</strong> The serum LPC levels at admission were significantly higher in the non-SCAP patients than in the SCAP patients (P = 0.011). Serum LPC level < 24.36 ng/mL, and PSI score were independent risk factors for the 30-day mortality in the elderly patients with CAP. The risk of 30-day mortality in the elderly CAP patients with low serum LPC levels (< 24.36ng/mL) was > 5-fold higher than in the patients with high serum LPC levels (≥ 24.36ng/mL).<br/><strong>Conclusion:</strong> Low serum LPC levels were associated with significantly higher disease severity and 30-day mortality in the elderly patients with CAP. Therefore, serum LPC is a promising predictive biomarker for the early identification of elderly CAP patients with poor prognosis.<br/><br/><strong>Keywords:</strong> lysophosphatidylcholine, community-acquired pneumonia, biomarker, severity, mortality, propensity score matching<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"81 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140171559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qianwen Chen, Qingqing Gu, Anwen Yin, Dabei Cai, Tingting Xiao, Yu Wang, Yuan Ji, Qingjie Wang, Jun Wei, Ling Sun
Objective: This study aimed to explore the association of preoperative neutrophil percentage (NEUT%) with the risk of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) having undergone coronary interventional therapy. Methods: A single-center, retrospective and observational study was conducted. From December 2012 to June 2021, patients with AMI were enrolled and divided into AKI group and non-AKI group. The NEUT% in the two groups was compared. The association between NEUT% with the risk of post-AMI AKI was analyzed by univariate and multivariable logistic regression. Kaplan-Meier survival curve was drawn to evaluate the prognostic ability of NEUT% for short-term all-cause death following AMI. Results: A total of 3001 consecutive patients were enrolled with an average age of 64.38 years. AKI occurred in 327 (10.9%) patients. The NEUT% was higher in the AKI group than in the non-AKI group ([76.65± 11.43]% versus [73.22± 11.83]%, P< 0.001). NEUT% was also identified as an independent risk factor for AKI in AMI patients after adjustment (OR=1.021, 95% CI: 1.010– 1.033, P < 0.001). Compared with those at the lowest quartile of NEUT%, the patients at quartiles 2– 4 had a higher risk of AKI (P for trend = 0.003). The odds of AKI increased by 29.0% as NEUT% increased by 1 standard deviation (OR=1.290, 95% CI: 1.087– 1.531, P = 0.004). After a median of 35 days follow-up, 93 patients died. Patients with a higher NEUT% presented a higher risk of all-cause death after AMI (Log rank: χ2 =24.753, P< 0.001). Conclusion: In AMI patients, the peripheral blood NEUT% was positively associated with the odds of AKI and short-term all-cause mortality. NEUT% may provide physicians with more information about disease development and prognosis.
{"title":"Neutrophil Percentage as a Potential Biomarker of Acute Kidney Injury Risk and Short-Term Prognosis in Patients with Acute Myocardial Infarction in the Elderly","authors":"Qianwen Chen, Qingqing Gu, Anwen Yin, Dabei Cai, Tingting Xiao, Yu Wang, Yuan Ji, Qingjie Wang, Jun Wei, Ling Sun","doi":"10.2147/cia.s455588","DOIUrl":"https://doi.org/10.2147/cia.s455588","url":null,"abstract":"<strong>Objective:</strong> This study aimed to explore the association of preoperative neutrophil percentage (NEUT%) with the risk of acute kidney injury (AKI) in patients with acute myocardial infarction (AMI) having undergone coronary interventional therapy.<br/><strong>Methods:</strong> A single-center, retrospective and observational study was conducted. From December 2012 to June 2021, patients with AMI were enrolled and divided into AKI group and non-AKI group. The NEUT% in the two groups was compared. The association between NEUT% with the risk of post-AMI AKI was analyzed by univariate and multivariable logistic regression. Kaplan-Meier survival curve was drawn to evaluate the prognostic ability of NEUT% for short-term all-cause death following AMI.<br/><strong>Results:</strong> A total of 3001 consecutive patients were enrolled with an average age of 64.38 years. AKI occurred in 327 (10.9%) patients. The NEUT% was higher in the AKI group than in the non-AKI group ([76.65± 11.43]% versus [73.22± 11.83]%, <em>P</em>< 0.001). NEUT% was also identified as an independent risk factor for AKI in AMI patients after adjustment (OR=1.021, 95% CI: 1.010– 1.033, <em>P</em> < 0.001). Compared with those at the lowest quartile of NEUT%, the patients at quartiles 2– 4 had a higher risk of AKI (<em>P</em> for trend = 0.003). The odds of AKI increased by 29.0% as NEUT% increased by 1 standard deviation (OR=1.290, 95% CI: 1.087– 1.531, <em>P</em> = 0.004). After a median of 35 days follow-up, 93 patients died. Patients with a higher NEUT% presented a higher risk of all-cause death after AMI (Log rank: χ<sup>2</sup> =24.753, <em>P</em>< 0.001).<br/><strong>Conclusion:</strong> In AMI patients, the peripheral blood NEUT% was positively associated with the odds of AKI and short-term all-cause mortality. NEUT% may provide physicians with more information about disease development and prognosis.<br/><br/><strong>Keywords:</strong> neutrophil percentage, acute kidney injury, acute myocardial infarction<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"36 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140148275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason Fanning, Amber Keller Brooks, Megan Bennett Irby, Kindia Williams N'Dah, W Jack Rejeski
Purpose: One’s amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period. Patients and Methods: Participants were low-active older adults (69.54± 6.74 years) with obesity and chronic pain who enrolled in one of two randomized controlled trials. Participants completed measures of pain intensity, interference, and health-related quality of life and wore an accelerometer for 7 days at baseline and week 12. Functional principal components analysis identified patterns of within-day stepping behavior at baseline, and linear regressions were used to investigate how these component scores related to pain and health-related quality of life at baseline and over 12 weeks. Results: Two patterns were extracted; one describing more vs less stepping and the second capturing movement later vs earlier in the day. More baseline stepping was associated with better physical functioning (B=0.148, p< 0.001) and energy (B=0.073, p=0.033), while a later start in the day was associated with worse social functioning (B=− 0.193, p=0.031). More stepping at baseline predicted positive changes in physical functioning (B=0.094, p=0.019), emotional role limitations (B=0.132, p=0.049), energy (B=0.112, p< 0.001), social functioning (B=0.086, p=0.043), pain (B=0.086, p=0.009), general health (B=0.081, p=0.003) and pain intensity (B=− 0.039, p=0.003). A later start to the day was associated with worsening physical functioning (B=− 0.229, p< 0.001), physical (B=− 0.282, p=0.047) and emotional role limitations (B=− 0.254, p=0.048), general health (B=− 0.108, p=0.041), and pain interference (B=0.055, p=0.043). Conclusion: Findings suggest there is value in activity patterns as an indicator for additional behavioral intervention, as those who move little and/or delay daily movement are likely to experience subsequent decrements in quality of life and pain symptoms.
Keywords: pain, patterns, physical activity, accelerometry, quality of life
{"title":"Associations Between Patterns of Daily Stepping Behavior, Health-Related Quality of Life, and Pain Symptoms Among Older Adults with Chronic Pain: A Secondary Analysis of Two Randomized Controlled Trials","authors":"Jason Fanning, Amber Keller Brooks, Megan Bennett Irby, Kindia Williams N'Dah, W Jack Rejeski","doi":"10.2147/cia.s453336","DOIUrl":"https://doi.org/10.2147/cia.s453336","url":null,"abstract":"<strong>Purpose:</strong> One’s amount, intensity, and distribution of physical activity may have implications for whether it has positive or negative effects on pain and quality of life for older adults living with chronic pain. Thus, we investigated baseline patterns of stepping related to pain symptoms and health-related quality of life at baseline and over a 12-week follow-up period.<br/><strong>Patients and Methods:</strong> Participants were low-active older adults (69.54± 6.74 years) with obesity and chronic pain who enrolled in one of two randomized controlled trials. Participants completed measures of pain intensity, interference, and health-related quality of life and wore an accelerometer for 7 days at baseline and week 12. Functional principal components analysis identified patterns of within-day stepping behavior at baseline, and linear regressions were used to investigate how these component scores related to pain and health-related quality of life at baseline and over 12 weeks.<br/><strong>Results:</strong> Two patterns were extracted; one describing more vs less stepping and the second capturing movement later vs earlier in the day. More baseline stepping was associated with better physical functioning (B=0.148, p< 0.001) and energy (B=0.073, p=0.033), while a later start in the day was associated with worse social functioning (B=− 0.193, p=0.031). More stepping at baseline predicted positive changes in physical functioning (B=0.094, p=0.019), emotional role limitations (B=0.132, p=0.049), energy (B=0.112, p< 0.001), social functioning (B=0.086, p=0.043), pain (B=0.086, p=0.009), general health (B=0.081, p=0.003) and pain intensity (B=− 0.039, p=0.003). A later start to the day was associated with worsening physical functioning (B=− 0.229, p< 0.001), physical (B=− 0.282, p=0.047) and emotional role limitations (B=− 0.254, p=0.048), general health (B=− 0.108, p=0.041), and pain interference (B=0.055, p=0.043).<br/><strong>Conclusion:</strong> Findings suggest there is value in activity patterns as an indicator for additional behavioral intervention, as those who move little and/or delay daily movement are likely to experience subsequent decrements in quality of life and pain symptoms.<br/><br/><strong>Keywords:</strong> pain, patterns, physical activity, accelerometry, quality of life<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"35 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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